4.6 Article

Flecainide Paradoxically Activates Cardiac Ryanodine Receptor Channels under Low Activity Conditions: A Potential Pro-Arrhythmic Action

Journal

CELLS
Volume 10, Issue 8, Pages -

Publisher

MDPI
DOI: 10.3390/cells10082101

Keywords

RyR2; RyR2-P2328S; flecainide; catecholaminergic polymorphic ventricular tachycardia; atrial fibrillation; RyR2 activation; RyR2 inhibition

Categories

Funding

  1. Australian National Health and Medical Research Council [APP108477]
  2. Medical Research Council [MR/M001288/1]
  3. Wellcome Trust [105727/Z/14/Z]
  4. British Heart Foundation [PG/14/79/31102, PG/15/12/31280, PG/19/59/34582]
  5. Isaac Newton Trust/Wellcome Trust ISSF/University of Cambridge Joint Research Grants Scheme
  6. Biotechnology and Biological Sciences Research Council (BBSRC) [BB/F023863/1]

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Research suggests that flecainide has complex effects on RyR2 channels, with different regulatory actions on channels with different open probabilities, exhibiting a dual mechanism of activation and inhibition.
Cardiac ryanodine receptor (RyR2) mutations are implicated in the potentially fatal catecholaminergic polymorphic ventricular tachycardia (CPVT) and in atrial fibrillation. CPVT has been successfully treated with flecainide monotherapy, with occasional notable exceptions. Reported actions of flecainide on cardiac sodium currents from mice carrying the pro-arrhythmic homozygotic RyR2-P2328S mutation prompted our explorations of the effects of flecainide on their RyR2 channels. Lipid bilayer electrophysiology techniques demonstrated a novel, paradoxical increase in RyR2 activity. Preceding flecainide exposure, channels were mildly activated by 1 mM luminal Ca2+ and 1 mu M cytoplasmic Ca2+, with open probabilities (P-o) of 0.03 +/- 0.01 (wild type, WT) or 0.096 +/- 0.024 (P2328S). Open probability (P-o) increased within 0.5 to 3 min of exposure to 0.5 to 5.0 mu M cytoplasmic flecainide, then declined with higher concentrations of flecainide. There were no such increases in a subset of high P-o channels with P-o >= 0.08, although P-o then declined with >= 5 mu M (WT) or >= 50 mu M flecainide (P2328S). On average, channels with P-o < 0.08 were significantly activated by 0.5 to 10 mu M of flecainide (WT) or 0.5 to 50 mu M of flecainide (P2328S). These results suggest that flecainide can bind to separate activation and inhibition sites on RyR2, with activation dominating in lower activity channels and inhibition dominating in more active channels.

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